2017 Section 7 Green Book

There were several notable clinical factors associated

with HRQOL. Consistently, individuals with comorbid

conditions, higher stages of cancer, and continued need for

a feeding tube reported poorer HRQOL on all domains

except social well-being. This result is consistent with a

large study by Terrell et al.,

who found that feeding tube

status and comorbid conditions were strong predictors of

HRQOL, and that stage of cancer was a moderate predic-

tor of HRQOL. The acute effects of radiation therapy had

a negative impact on physical and functional well-being

and increased HNC-associated symptoms. The literature

supports this finding: irradiation has been associated with

several side effects, including dry mouth, difficulty swal-

lowing, mouth and gum sores, fatigue, nausea, and lym-

phedema.

9,28–31,43

Our study found that the detrimental

effects of radiation therapy lessened over the years such

that Functional HRQOL was similar to those who were

not irradiated by 2 years, and physical well-being was sim-

ilar between those who did and didn’t receive radiation

therapy by four or five years postdiagnosis.

Limitations

There were several limitations of this study. All partici-

pants were receiving care in North Carolina. Although the

sample was heterogeneous with respect to race, socioeco-

nomic status, and clinical factors, it may not be generalizable

to the U.S. population. The measures of HRQOL were added

to the study after the parent study had begun, thus resulting

in lower sample sizes at the baseline 3-month (median)

assessment point. We did not have a pretreatment measure

of HRQOL to know to what extent HRQOL differences

existed prior to treatment. Future studies are recommended

to better understand the factors associated with HRQOL in

HNC patients. Strengths include the population-based rela-

tively large sample size and diverse population with multiple

follow-up surveys. Human papillomavirus infection has been

shown to be a risk factor for HNC, especially cancer of the

base of tongue, tonsils, and oropharynx.

We did not have

HPV data on all cases included in this analysis, and because

its potential association with HRQOL is mediated only

through treatment, we did not consider HPVas a covariate.

CONCLUSION

Despite these limitations, this study contributes to

the literature by identifying sociodemographic, behav-

ioral, and clinical factors associated with poorer HRQOL

for HNC survivors. Understanding these factors will

help to identify those at risk for decrements in HRQOL.

Some factors, such as tobacco use, can be modifiable by

encouraging patients to participate in smoking cessation

program. For other factors, awareness of these factors

can help to identify those at risk and provide more long-

term care and surveillance to reduce the deleterious

effects of the cancer and its treatment. The acute ill

effects of radiation therapy on HRQOL seem to decrease

significantly over time and return to levels seen in non-

irradiated patients by 2 to 4 years posttherapy.

Enhanced psychological and social support may help

with issues of depression and dealing with the physical

effects of surgery and radiation.

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Reeve et al.: Factors Associated With Quality of Life

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